Dr Rhonda Jolly
Delivering on promises
The health workforce measures in this Budget are mostly aimed at delivering on the Government’s promises made during the 2013 election campaign.[1] In addition, one recommendation of the National Commission of Audit (NCoA) has been included in the budget measures—the abolition of two health bureaucracy bodies, Health Workforce Australia (HWA) and General Practice Education and Training Limited (GPET).
No response was made in the Budget to the important recommendation made by the NCoA for consideration of substantial changes to the delivery of health workforce services. Health analysts have advocated for some time that extended practice for suitably qualified professionals, such as nurses and pharmacists and physician assistants, would enhance the delivery of care and reduce health care costs for patients and for the system overall.[2] Recent research by the Grattan Institute has also concluded:
Enabling less highly-trained hospital workers to play a bigger role could improve jobs for doctors and nurses, save public hospitals nearly $430 million a year and fund treatment for more than 85,000 extra people.
Doctors, nurses and allied health professionals such as physiotherapists and occupational therapists are all squandering their valuable skills on work that other people could do.
It doesn’t take 15 years of training to provide light sedation for a stable patient having a simple procedure, or a three-year degree to help someone bathe or eat – but that is the situation in Australian hospitals today.[3]
The NCoA echoed this view in concluding that to cope with an expected rise in demand for health services in the future, it would be advantageous for the Government to examine the scope of existing practitioners and reassess skills mixes to achieve more flexibility. It noted:
Australia’s arrangements for the scope of professional practices and the appropriate skills mix for health professionals are less flexible than in other countries. Many health professionals report less qualified staff could safely undertake a significant share of their work.
Health Workforce Australia has initiated an Expanded Scope of Practice programme aimed at redesigning roles of the health workforce to improve productivity, retention, efficiency and effectiveness of health care services. This reform can go further.
In particular, pharmacists and nurse practitioners could, in an expanded range of settings provide immunisations, monitor blood pressure and diabetes tests, issue medical certificates for certain conditions (such as colds or hay fever) and undertake some prescribing for chronic conditions following an initial diagnosis and prescription by a doctor. [4]
However, given that turf protection is entrenched in the various health workforces and the minimal success of earlier forays into workforce reform of this nature, it is not surprising that the Government has yet to respond to the NCoA’s suggestions.[5]
Budget measures: nursing and allied workforce
The Budget provides funding of $13.4 million over three years to fund 500 additional nursing and allied health scholarships. The scholarships will be valued up to $30,000 each and will target workforce shortages in rural and remote areas[6]. At the same time, it should be noted that the Government cancelled a Tasmanian nursing and allied health scholarships measure to achieve savings of $9.9 million over four years. According to the budget papers, savings from the Tasmanian scheme will be invested in the Medical Research Future fund to be created under another budget measure. It could be argued therefore that in effect, new investment in the nursing and allied workforces amounts to only $3.5 million over three years.
Nonetheless, the new scholarships were welcomed by the Australian College of Nursing as a measure which will be able to attract nurses to work in rural health services and provide professional development support for of those nurses already practicing in rural settings.[7]
The other measure directly affecting nursing in the Budget is the continuation of funding for the mental health nursing incentive program. Funding of $23.4 million has been provided for 2014–15 to maintain services at current levels. The Australian College of Mental Health Nurses has indicated that it will lobby the Government for permanent funding allocation following restructuring of the program in response to a 2013 evaluation.[8]
Budget measures: medical workforce
There are a number of measures in this Budget which will affect the current and future supply of medical practitioners.
- The Budget doubles the teaching payment to general practitioners for training medical students from $100 to $200 for each three hour session delivered ($238.4 million over five years).
- Infrastructure grants for at least 175 existing rural and remote general practices is another budget measure. To be eligible for funding (capped at $300,000) under this program, which will deliver $52.5 million over three years, practices will be required to match the Government’s infrastructure contribution.
- The Budget will provide $35.4 million over two years to meet increased demand from general practitioners for incentive payments, which encourage the general practitioners to work in rural and remote areas.
- Finally, the Budget provides for 300 extra government funded general practice training places. This will increase the total number of training practices to 1,500 in 2015.
All these measures appear to have been well received by stakeholders.
Budget measures: demise of Health Workforce Australia and GPET
According to the budget papers, efficiencies achieved by abolishing the bureaucracy and red tape associated with GPET and HWA and consolidating the bodies within the Department of Health will be largely sufficient to fund the additional training places promised ($257.4 million over five years).
A number of stakeholders are not enthusiastic about closure of these bodies. The Australian Medical Association, for example, considers the mergers may ‘undermine the capacity to undertake essential medical workforce planning to ensure the community has access to the right number of doctors in the right places’.[9]
These concerns are not without foundation, especially in the case of HWA. Workforce planning, essential in addressing skills shortages and structural inefficiencies across the various health workforces, requires specialised skills and far-sighted thinking. HWA, an independent body with a clear mandate to build capacity, boost production and improve distribution of the health workforce, has produced research and trialled initiatives calculated to achieve these aims. To what extent a government department will be able to deliver independent analysis in these areas remains to be seen.
[2]. See for example: P. Brooks, ‘The health workforce of the future–partnerships in health care’, Australian Health Consumer, 2, 2005–2006.
[8]. Australian College of Mental Health Nurses, Budget 2014–15, 2014, accessed 16 May 2014.
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